Brain Metastases   

Questions discussed in this category


The patient is treatment naïve and asymptomatic. She also has disease in the body (bone and liver metastases). 

What maximum dose do you allow to “connect” adjacent metastatic lesions receiving SRS/SRT? What is this value for one-, three-, and five-...

How does the presence of prior WBRT alter your treatment plan?

This has become standard practice at our institution for patients with a good performance status, with whole brain radiotherapy given after the comple...

A HA-WBRT patient developed brisk mucositis on the soft palate at fraction 8/10

Is there evidence that supports/refutes the safety of concurrent use?

How should they be prioritized? V10, V12, mean brain dose, prior WB radiation? To what extent should tumor coverage, conformality and homogeneity be c...

Can SRS or whole brain radiotherapy be reserved for progression in these young, healthy patients?

Do you increase dosage of the TKI or switch to a different generation TKI?  How does your answer differ for EGFR vs. ALK, and for discerete brain...

Do you modify your dose/fractionation depending on the amount of prior intrathecal therapy?

There are solid data from Emory, Korea and others suggesting that is as effective as single fraction SRS but has less complications. 

The 2014 "Choosing Wisely" list, released this past September, includes the assertion that we should not "routinely add adjuvant whole brain radiation...

Some medical oncologists tend to hold anticoagulation in patients who develop brain metastases for fear of causing intracranial hemorrhage.  Is t...

Does the extent/duration of systemic disease control (complete response vs. stable disease, for example) influence your decision?  What about whe...

What are the best options to treat a patient with brain metastasis confined to the posterior fossa if the patient is young, has a favorable cancer, gr...

Based on recent ASTRO data, what is your selection criteria and size cutoffs?

In patients with contraindications to receiving an MRI scan, are other imaging modalities sufficient to treat patients with SRS?

In a patient with multiple brain metastases from NSCLC, is this reasonable?

The most frequent argument against whole brain RT is debilitating toxicity. However, I am having a hard time finding the most evidence based data on h...

While the Duke randomized study found similar rates of control with 1mm v. 3mm margins and higher radionecrosis with 3mm, it did not look at treating ...

It is my impression that for brain metastases >3 cm it may be preferable to deliver fractionated SRT versus the RTOG dose of 15 Gy SRS, if WBRT is ...


Papers discussed in this category


Clinical oncology (Royal College of Radiologists (Great Britain)), 2007-09

Radiation oncology (London, England), 2014-01-03

N Engl J Med, 2007 Aug 16

J Clin Oncol, 1999 Jul

Lancet, 2015 Jan 3

International journal of radiation oncology, biology, physics, 2011-11-01

Int. J. Radiat. Oncol. Biol. Phys., 2006-09-01

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2017-12

Lancet Oncol., 2017-05-01

The New England journal of medicine, 1999-08-12

BMC Cancer, 2015-08-15

Journal of cancer research and therapeutics, 2012

International journal of radiation oncology, biology, physics, 2012-05-01

Neurosurgery, 2013-10

Practical radiation oncology, 2015

J. Neurosurg., 2005-01-01

J Korean Neurosurg Soc, 2011-08-01

Radiat Oncol, 2014-07-08

BMC Cancer, 2015-03-04

Acta Neurochir (Wien), 2013-01-01

The Lancet. Oncology, 2009-11

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2007-04-01

J Clin Oncol, 2011 Jan 10

JAMA, 2016-07-26

Radiation oncology (London, England), 2014-09-30

Cancer, 2016-06-15

J. Clin. Oncol., 2018 May 22

Lung cancer (Amsterdam, Netherlands), 2018-06

The New England journal of medicine, 2018-08-23

The New England journal of medicine, 2018-12-06

International journal of radiation oncology, biology, physics, 2019-04-01

Lancet, 2019 Oct 04

JAMA oncology, 2019-06-01

International journal of radiation oncology, biology, physics, 2019-04-01

International journal of radiation oncology, biology, physics, 2019-04-01

Neurosurgery, 2019 Oct 10

JAMA Oncol, 2020 Jun 4

J Clin Oncol, 2020 Aug 10

Lung Cancer, 2014 Aug 02

N Engl J Med,

Lancet Oncol, 2020 Apr 03

Int J Radiat Oncol Biol Phys,

JAMA,

J Neurosurg,

Cancer,

JAMA, 1998 Nov 4

Journal of neurosurgery, 2010-12

Lancet Oncol, 2014 Apr

J Neurosurg, 2014 Dec

Stereotactic and functional neurosurgery, 2017

Cancer treatment reviews, 2011-11

Neuro-oncology, 2013-10

International journal of radiation oncology, biology, physics, 2018-03-15

International journal of radiation oncology, biology, physics, 2016-06-01

Int. J. Radiat. Oncol. Biol. Phys.,

Radiat Oncol, 2015 May 27

International journal of radiation oncology, biology, physics, 2016-06-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-04-01

The New England journal of medicine, 2016-11-10

The New England journal of medicine, 2018-01-11

N. Engl. J. Med.,

Blood, 2015-07-23

International journal of radiation oncology, biology, physics, 2016-06-01

Radiat Oncol, 2011-12-21

Medical physics, 2010-08

Neurosurgery, 2010-03

International journal of radiation oncology, biology, physics, 2010-01-01

Int. J. Radiat. Oncol. Biol. Phys., 2016-07-15

International journal of radiation oncology, biology, physics, 2019-03-01

Journal of neurosurgery, 2006-06

International journal of radiation oncology, biology, physics, 2013-03-01

American journal of clinical oncology, 2015-04

Int J Radiat Oncol Biol Phys, 2000 May 1

Neurosurgery, 2016-08

Journal of neuro-oncology, 2017-02

International journal of radiation oncology, biology, physics, 2014-03-15

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2017-05

J. Neurooncol., 2012-08-01

Int. J. Radiat. Oncol. Biol. Phys., 2009-08-01

The Lancet. Oncology, 2017-08

International journal of radiation oncology, biology, physics, 2017-09-01

Neurosurgery, 2018-07-01

Int. J. Radiat. Oncol. Biol. Phys., 2013 May 15

Neurosurgery, 2019-01-01

Journal of neurosurgery, 2009-09

Radiother Oncol,

Radiat Oncol, 2014 Jun 10

J Neurosurg, 2017 Sep 22

Radiat Oncol, 2020 May 28

Neurosurgery, 2013-02

Journal of computer assisted tomography, 2014

Int. J. Radiat. Oncol. Biol. Phys.,

Oper Neurosurg (Hagerstown), 2015 Aug 01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2012-07-20

J. Clin. Oncol., 2020 Feb 14

Cureus, 2017 Dec 25

N Engl J Med, 2021 Apr 22